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DEFINING QUALITY

The definition of quality depends on the field being evaluated. For example, although they each provide food and housing, the definitions for high-quality hotels, prisons, and hospitals will be considerably different. The International Organization for Standardization defines quality broadly as “the totality of features and characteristics of a product or service that bears on its ability to satisfy stated or implied needs” (ISO 8402–1986 standard). In health care, quality has been abstractly defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”1 Although a bit vague, this definition emphasizes two challenging aspects of measuring the quality of health care: (1) the need to improve outcomes and (2) the importance of evidence. Throughout this chapter, we will focus on these two concepts to discuss measuring quality through evidence-based processes of care that should ultimately lead to improved outcomes.

WHY DO WE MEASURE QUALITY?

“Count what is countable, measure what is measurable, and what is not measurable, make measurable” is frequently attributed to Galileo.2 The ability to manage outcomes or processes of care is fundamentally tied to being able to measure them. Finding clinically relevant, measurable, and actionable outcomes and processes in health care is necessary to provide clinicians with the ability to improve their systems. This is not to say that all important determinants of quality can be measured or that those that cannot be measured should be ignored. Deming, the grandfather of quality metrics, once stated that “running a company on visible figures alone” is one of the seven deadly sins of management.3 However, to demonstrate improvement or to detect deviations ...